All for the love of a king Thousands race through weekend downpour with no clue what fistula is

Time check is 5:30am and it is Sunday April 6.

I am nestled deep in the warmth of my bed listening to the rain’s music on the iron roof above me. It had only been a few hours since drowsiness had overwhelmed me, the heaviness of my head bringing me down to rest upon the soft mattress.

No sooner had I put my head back down than a thought rushed through my mind like a gushing wind: I was supposed to be running 21 km in the next 90 minutes.

Not from my home, but from Lubiri, Mengo where thousands of people had registered to run to raise money for women suffering from fistula, as a commemoration of the Kabaka’s (king of Buganda Kingdom) 59^th birthday.

A fistula is a tear between the birth passage and the bladder or rectum, caused by obstructed and prolonged labour.  During this time, the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bones.

The lack of blood flow causes tissue to die, creating a hole between the mother’s vagina and bladder, or between the vagina and rectum, or both, resulting in leakage.

The race’s main sponsor was Airtel together with Buganda kingdom and others.

I swiftly rose from my comfort and drew my coarse green curtains apart. Darkness was lingering in the sky and the downpour seemed to be getting heavier with each passing minute.

I thought, “Was anyone going to risk their lives and run in this rain and cold?” But I answered myself immediately: “Oh yes… Ninsiima. You are joking with the Baganda and their Kabaka. Because of him, they will do anything.”

I fixed a quick breakfast, called my regular boda boda taxi and jolted off to Lubiri at 6:40am.

In the unrelenting rain, I set my feet on the now gullied ground at 7.05am. And lo! A huge crowd was already gathered.

Each runner wore a red t-shirt with the words, ‘Kabaka’s birthday race 2014: Fight against fistula.’ Their sneakers in different colours lit up the soaked grounds. 

Then King Ronald Muwenda Mutebi II pulled into the grounds, wearing a maroon shirt, light brown trousers and a grey coat. He was accompanied by his prime minister, Charles Peter Mayiga who donned a dark blue tracksuit, red t-shirt and black boots.

The Kabaka’s arrival was met with so much noise, the splash of muddy water as excited feet stomped the soaked grounds, cheering and whistling.

Guarded from the rain with a huge umbrella, Mutebi stood in the runners’ path holding a flag.

Although the race which was supposed to have begun at 7am, it was delayed by about 30 minutes, yet none of the runners – going for five, 10 and 21 kilometres – seemed bothered as the rain hammered them. 

To my left, a group of young ladies wiped the rain water from their faces and to my right two children, about 10 and seven years old, pulled their soaked cardigans closer for warmth.

At the rise and fall of the flag in the king’s hands, the runners, like a herd of elephants, took off. 

As I panted along, my eyes caught a glimpse of MPs, John Ken Lukyamuzi, Lulume Bayigga and Joseph Sewungu Gonzaga.

As we whizzed through Nakulabye, I wondered whether all the runners had any idea what fistula was. I asked and the answers were very disappointing.

One lady running proudly along told me: “It is a swelling in the stomach”.

And  another: “It is the remaining parts of a foetus in the uterus after one has had an abortion”, and yet another: “The side effects of a C-Section.” Hmm. Well, at least they were running the marathon having paid Shs 10,000 each; their education could wait another day.

I realised majority of the participants in the race were running just because the Kabaka had asked them to!

My curiosity turned to the men. There was this old man, with grey locked hair, racing along in a white kanzu and chanting: ‘yogaayoga ai ssabassajja! (oh hail the king!)’

I joined him in chorusing the phrase. After establishing rapport, I asked, “By the way, what is fistula?”

And his answer: “Nze ebyo tebinkwatako… tuddukira kabaka waffe (those things do not concern me…we are running for our king.”

Some runners were so committed to their king’s cause, they came up with ‘better’ costumes; one woman ran the race in Buganda’s traditional dress, the busuuti.

At least after unbelievable rounds of wrong answers, one gentleman managed to tell me what a fistula, in its correctness, was.

After advancing through a few familiar places such as Wandegeya and Kampala road, paralysing traffic, I felt excellent. I knew I had run for at least three kilometres. But as we huffed and puffed the rest of the journey away, my legs felt heavy and I felt a stitch in my sides.

I resorted to walking just like many who had started off with vigour. I later spotted musician and dancer, Sarah Short, Uganda Police publicist, Judith Nabakooba, Makindye division boss Dr Ian Clark and the marathon’s chief runner, Mutebi’s younger brother Prince David Kintu Wassajja, who was drenched to the bone.

That man would possibly look fine wearing sack cloth! 

Prince Wasajja (in maroon) runs towards the finishing point

The intensity of the rain made the ground slippery and hard for people to maintain a firm grip against the surface. But two hours later, the winner of the 21km stretch, Gonzaga Ssebuuma made it back to the sodden Lubiri grounds.

Those that had run or walked the five and 10km stretches had arrived earlier and were being sensitized on what fistula was.

My group made it to the grounds at 10:45am, to the sight of vendors, food sellers and bodies moving to the rhythm of local music.

Some of the lyrics gave me the giggles: “I am like Ssemakookiro (Kabaka’s youngest son). I even have ebiwawatiro (wings) and land in miles.’

We then lined up on either side at the finishing point to wait for the chief runner. To keep our spirits alive, we were treated to bouts of comedy from the emcees and more music.

Then behold, the prince in a maroon t-shirt, black shorts and green cardigan looped around his waist run his way into the grounds at exactly 11:10am.

His sneakers and legs spluttered with mud, Prince Wassajja acknowledged the deafening ululation by imitating sprinter Ussain Bolt’s trademark pointing celebration after winning a race. 

That drew even louder cheers.

Then the last runner, Vision Group’s CEO, Robert Kabushenga, showed up about 30 minutes after Wassajja, a bunch of yellow bananas in hand.

Like the bananas, the day’s events ripened with the katikkiro Mayiga urging participants to continue supporting women living with challenges of fistula.

He also reminded them to support Kabaka’s main birthday celebrations on April 13, to be held with students of Gombe Secondary School.

Although it was already a few minutes after midday, the events of the day seemed to have consumed the participants, cloaking them in dance, food and drink.

After all, the rain made the day both chilling and thrilling.

Bailed out of prostitution, Nansubuga returns favour

There are stories one would never, not even in their wildest nightmare, wish on themselves or anyone.
Imagine one misogynistic man, probably 20 years your daughter’s senior, having sex with her all in exchange for peanuts.

These men buy sex from these young girls and think they are in a mutually benefitting affair.

This is the story of real-life girls forced into the age-old trade, and their struggle to move on.

Nansubuga's life story

Mariam Nansubuga, 30, was forced into prostitution as a child, turning to drugs and getting addicted to them, in order to stomach the torture of having sex with at least four men each night.

Nansubuga was orphaned at the age of six, after her father died in 1989. Her mother had died two months after Nansubuga was born. A surviving stepmother was one hell of a ruthless being. She even denied her a chance to see a blackboard beyond kindergarten’s top class.

When the stepmother’s insults intensified, Nansubuga ran away from home in Luweero in 1990, at age seven.

“I moved to Wobulenzi and slept on a veranda the first night before I set out in the morning to look for petty jobs that I could do to raise some money,” Nansubuga says.

Luckily, one woman gave her a job as a housemaid for six months before referring her to her sister in Gayaza. She received no pay for her efforts and this prompted her to leave just after six months of her transfer.

She then stayed with her childhood friend in Komamboga but had to pay rent. This was in 1992 when she was just nine. Unknown to Nansubuga, this friend was a sex worker who later introduced the nine-year-old to sex trade.

Launching into the unknown

One night with the moon high, Nansubuga joined her friend to sell their bodies. The thought of having intercourse at that tender age made Nansubuga squeamishly uncomfortable. But she had to do it; letting men old enough to be her grandfathers use her for sexual gratification.

While every girl remembers the day she lost her virginity for quite different reasons, Nansubuga remembers how much she sold hers.

“On my very first night, I earned Shs 3,000 but the experience was horrible. I bled, felt pain and did not enjoy it. How couldn’t this ‘defiler’ see that I was a child?”

Nansubuga tells me with agitation in her voice that one could cut through with a knife. Her immaturity and naivety seemed not to move her ‘professional’ friend who bought her painkillers to ease the pain.

Still she had to work in order to raise Shs 30,000 for their Shs 60,000 room. On her second day, she received three clients. 

Slowly, her fear was abated. Soon, men seemed to prefer her – the pre-puberty child – to the ‘old brooms’ which did not go down well with them because she started to make more money than them.

Together with her roommate, they moved to different places including Kalerwe, Kampala Casino, Ange Noir until they finally shifted to Bwaise’s notorious Kimombasa in 1995.
Within a month, she was making Shs 12,000 a night.

“I upgraded my skills and worked even harder because I saw it as the only alternative for income, although I did not enjoy even one session,” the mother of seven says.

“Once, a man took me to a lodge and paid me Shs 20,000. He used me for six straight hours. It clocked 5:30am and he still had energy for another one hour till 6:30am,” she says.

“When it was time to go, he escorted me to get a boda boda back home and the unthinkable happened. He grabbed me by the neck and told me to return his Shs 20,000 and also give him what I had already made. I walked home that morning, crying and in despair.”

“Another paid me Shs 10,000 for a short [engagement] and took me to his home. When I reached home, there were about four other men and they all used me in turn from 9pm to 1am. I was 11 years old then. Despite my screaming, no one intervened.”

Experimenting with drugs and alcohol

In order to withstand the cold and assaults, Nansubuga was introduced to a cocktail of drugs such as marijuana, mairungi and jet fuel.

“During day time, we would be drunk and this was meant to charge us for the night so that we could withstand all sorts of men, especially those who did not want to wear condoms,” Nansubuga said.

She surrounded herself with smokers, bandits and drunkards. Soon, she got herself a boyfriend, a former client.

Her boyfriend was no lover but a vicious pimp who left her pregnant at 13 years old. Her pregnancy was another nightmare plagued with frequent illness, vomiting and weight loss.

Then the worst part came during labour at Mulago hospital, a process that lasted five days, worrying doctors and nurses. It was later discovered that her system was clogged with drugs, which disrupted the delivery process.

“I spent three months on oxygen and it took me almost a full year to walk upright again. In fact, this birth affected me because I still limp a little,” she laments.

And to think she was only arriving at the door of adolescence, the age when most girls are only discovering their bodies and hormones. Yet here she was, a thoroughly sexually-experienced mother.

“After birth, my child was taken to the special care unit because I was still very weak.”

For six months, she remained bed-ridden and did not take to the streets until after a year.

Yet two years later, in 1998, Nansubuga was to become pregnant again. This time, she did not know the child’s father. And so it was with her third pregnancy in 1999. Bad luck struck that year too. Her friend and roommate passed away.

Lease of life

After recovering from that death, she worked herself hoarse, this time sleeping with about eight men each night to fend for her children. She always had a desire to abandon the trade but saw no way out.

Then in 2007, Reproductive Health Uganda (RHU), an NGO promoting sexual and reproductive health and rights services, identified her and many others through its scouts.

The organization was holding a one-week entrepreneurship training for ‘moonlight stars’ at Tick hotel in Kawempe.

“I initially had refused their offer because I knew it would be a waste of time. But the scouts persisted and said they would pay us and give us start-up capital for businesses,” Nansubuga says, adding that about 20 of at least 60 prostitutes turned up.

It was worthwhile. The entrepreneurship training aside, they also received counselling and volunteering skills she uses to-date. She was given Shs 100,000 as start-up capital for her new job of vending clothes and selling cassava. On average, these bring her Shs 250,000 a month.

She is also one of 90 peer educators at the RHU Moonlight Star Clinic in Bwaise where I found her counselling a youth on family planning. The clinic’s in-charge, Mariam Mugambi, told me Nansubuga is now a great resource in the clinic.

“She labours to do cross counselling and advising those still in the trade to join her because of the dangers accruing, such as unwanted pregnancies and STIs,” Mugambi said.

In her long-term plans, Nansubuga hopes to build a house. In 2008, she met and is staying with the father of her four youngest children. But the journey to quit sex work has not been a smooth one.

“I still get phone calls from some men asking to sleep with them, but I have resisted the urge and I am concentrating on my businesses.”

Her friend, Edith Nakiganda, 26, is now making a living out of baking cakes. She was trained and given start-up capital of Shs 200,000 by RHU after bailing her out of sex trade in 2007.

Each of these women admits it is only when they left that they realised that prostitution is the worst slime in the cesspool of life. But when, like Nansubuga, prostitution is what life handed you in place of a doll as a young girl, you probably don’t know any better.

Thanks to RHU, the former sex workers have a real shot at normalcy; if they can put their lost childhoods behind them permanently, that is.

ninsiima@observer.ug

Cancer to hit 24m Cases annually in 20 years

One the eve of World Cancer day, a report released on from the International Agency for Research on Cancer (IARC) shows some disappointing figures for the global fight against cancer. By 2030, cancers are expected to jump from 14 million in 2012 to 21.6 million a year, and overall deaths are expected to increase from 8.2 million to 13 million annually.

 Lung cancer is the biggest killer, and the report criticizes tobacco companies' push into poorer countries. It said a smoking “epidemic” is “potentially impeding human development by consuming scarce resources, increasing pressures on already weak health-care systems, and inhibiting national productivity.”

The world is facing a "tidal wave" of cancer, and restrictions on alcohol and sugar need to be considered, say World Health Organization scientists.

It predicts the number of cancer cases will reach 24 million a year by 2035, but half could be prevented.

In Uganda, some 3000 new people afflicted with various cancers will have presented themselves at the Uganda Cancer institute (UCI), the only cancer referral facility in the country for treatment by the end of 2014. 

This is because of the increase in infections malaria, HIV, Hepatitis B, Human Papilloma Virus (HPV) and typhoid. Infection-related cancers include Burkitt’s lymphoma, associated with malaria and affects children between four and seven years, Kaposi's sarcoma caused by the Human Herpes Virus 8 (HHV8) whose risk increases dramatically in people with HIV infection and Hepatocellular Carcinoma (cancer of the liver) caused by the Hepatitis B Virus (HBV).

The UCI director, Dr. Jackson Orem says HIV has accelerated the burden of cancer in the country so much so that 60 percent of cancers in adults at UCI are related to HIV.

“Thirty percent of cancers in developing countries are related to infection. Most cancer patients in Uganda are young and in their prime as opposed to elderly population in the developed world,” he said in an interview with the Observer.

Dr. Orem adds that institute is seeing an influx of children afflicted with Burkett’s lymphoma, a potentially fatal and disfiguring cancer that often develops in the jaw or abdomen caused by the Epstein-Barr virus that is as a result of frequent and ill-treated malaria.

Other infection related cancers include; blood, cervical, bladder and stomach cancers.

Worldwide, cancer kills more people than AIDS, tuberculosis, and malaria combined and has become a leading cause of death in the world. (WHO) estimates that by 2030 more than 12 million people could die from cancer related diseases. About 80 per cent of these deaths are likely to occur in low-income and middle-income countries such as Uganda.

Currently, according to information from the Non-communicable disease unit of the health ministry, 300 people per every 100,000 are estimated to have cancers

Last year, UCI recorded a total of 2800 patients with infection related cancers last year accounting for more than 50 per cent of the cancer burden in the country.

“If the infections are not reduced sooner than later, cancer is going to be the next big epidemic in the country,” Dr Fred Okuku, a senior oncologist at UCI warns.

The WHO said there was now a "real need" to focus on cancer prevention by tackling smoking, obesity and drinking.

The World Cancer Research Fund said there was an "alarming" level of naivety about diet's role in cancer.

Fourteen million people a year are diagnosed with cancer, but that is predicted to increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.

The developing world will bear the brunt of the extra cases.

Dr Chris Wild, the director of the WHO's International Agency for Research on Cancer, told the BBC: "The global cancer burden is increasing and quite markedly, due predominately to the ageing of the populations and population growth.

“If we look at the cost of treatment of cancers, it is spiralling out of control, even for the high-income countries. Prevention is absolutely critical and it's been somewhat neglected.”

The WHO's World Cancer Report 2014 said the major sources of preventable cancer included:

·         Smoking

·         Infections

·         Alcohol

·         Obesity and inactivity

·         Radiation, both from the sun and medical scans

·         Air pollution and other environmental factors

·         Delayed parenthood, having fewer children and not breastfeeding

For most countries, breast cancer is the most common cancer in women. However, cervical cancer dominates in large parts of Africa.

The human papillomavirus (HPV) is a major cause. It is thought wider use of the HPV and other vaccines could prevent hundreds of thousands of cancers.

One of the report's editors, Dr Bernard Stewart from the University of New South Wales in Australia, said prevention had a "crucial role in combating the tidal wave of cancer which we see coming across the world".

Dr Stewart said human behavior was behind many cancers such as the sunbathe "until you're cooked evenly on both sides" approach in his native Australia.

He said it was not the role of the International Agency for Research on Cancer to dictate what should be done.

But he added: "In relation to alcohol, for example, we're all aware of the acute effects, whether it's car accidents or assaults, but there's a burden of disease that's not talked about because it's simply not recognised, specifically involving cancer.

“The extent to which we modify the availability of alcohol, the labelling of alcohol, the promotion of alcohol and the price of alcohol - those things should be on the agenda.”

He said there was a similar argument to be had with sugar fuelling obesity, which in turn affected cancer risk.

Meanwhile, UCI has been chosen by the International Atomic Energy Agency (IAEA) to host the Virtual University for Cancer Control (VUCCnet)- a regional centre for excellence for Cancer training in East Africa.

Currently, the modern Lymphoma Treatment Centre is nearing completion and it is expected to accommodate 100 patients at any one time.

6 questions journalists should be able to answer before pitching a story

By Tom Huang

I can’t believe that my former editor never threw me out of his office. That’s because, back when I was a cub reporter, I used to pitch story ideas by proclaiming that I wanted to write about “the homeless,” or “drug gangs,” or “teen mothers.”

While these were interesting and important topics, that’s all they were — topics. They didn’t have enough shape or specificity to be ideas.

Several months passed before I finally learned how important it was to do research to support a story idea. I realized I could do “pre-reporting” without getting too invested in a story. I could read previous stories and interview a few sources to have a better sense of what the story might be about.

And with that background, I could pitch my ideas in the form of a small quest: “The number of homeless families is increasing in the suburbs, and I’d like to find out why.” “Juries seem to be particularly unforgiving of drug gang members, and I’d like to see what prosecutors and defense attorneys have to say about that.” “A school has started a program for teen mothers, and I’d like to examine who’s behind it and what they hope to accomplish.”

Story pitches can come in all formats. (The narrative blog, Gangrey.com, has a good piece on pitches — particularly magazine story pitches — here.) Pitches can vary depending on the reporter’s track record, and how long the reporter and editor have worked together. In general, the more the editor and reporter have worked together, the more they can communicate in shorthand.

But regardless of the reporter’s experience or how mature the editor-reporter relationship is, I think it’s important for the reporter to be able to answer a handful of questions before pitching the story to his or her editor. These are questions for both reporters and editors to ask.
What piques your curiosity about the story?
I always ask this when a reporter approaches me with an idea. I want to know whether she is genuinely interested in the idea and whether her curiosity will drive her to seek the answers she needs to tell the story. I want to know what aspect of the story first caught her attention. If she ever gets lost in the weeds during the reporting, I can remind her about the initial moment of intrigue. Finally, I want to understand how the writer thinks. What topics are of natural interest to her? Where is she getting her ideas from? What is she reading?


What’s new about the story, and why do you want to tell it now?

I want the reporter to have done enough research to understand where the story lies in a timeline. What previous events have led to the current situation? Give me that context. Then let me know what’s new about the situation. Does the story reflect a new trend, a turning point, the start or the end of a conflict? Do we need to tell the story in advance of an upcoming decision, meeting or event?

Such “news pegs” can be limiting, and I’ve often argued that we should be able to publish stories just because they are good stories. But given how busy readers are and how many distractions they face, it helps if a story — even “just a good story” — has a compelling reason to be told today.

Why will the reader or viewer care about the story?

Yes, I’d like to know why a reporter is curious about a story idea. But I’d also like him to step outside of his reporter’s role and think as a reader or viewer. How can we frame the story in a way that’s relevant to the average person? This is where the reporter considers why the story would grab the attention of his parents or, say, his friends at a bar (or his parents at a bar).
Not that his parents or friends are average people, but they live outside the newsroom (which can sometimes become fixated on a story that’s not relevant to others). Ordinary people are most concerned about their finances, health and safety. And if they have kids, they’re probably concerned about all of that, plus education. Does the reporter’s story idea touch upon any of these issues?


How can we tell this story digitally?

We are increasingly telling our stories across platforms — on the Web and on tablets and other digital devices. It’s important for the reporter to develop a sharp sense of what kinds of storytelling work well on different platforms. In addition to producing the traditional story, could we create short videos of the people in the story for an online package? Are there any ways of telling the story through an interactive graphic that would work on the iPad?

I’m not expecting the reporter to produce these packages himself. But I’d like him to have the judgment to say, “Here are the components in my story idea that I think would lend themselves to digital storytelling.”


What questions will you need to ask to get this story, and what sources will you need to consult?
Since this is still the ideas phase, I’m not expecting the reporter to know what the story is going to say. I hope that he has a hypothesis that he’s going to test through his reporting. That’s why I’d like to know at least three or four questions that the reporter wants to ask, plus two or three sources he’ll consult. I’d also like to know whether there’s a central question that the reporter is trying to answer in the story. The central question can help us focus the story after he’s done most of his reporting.


How much time will you need to produce the story, and how much space/time do you think the story deserves?

As an editor, I think it’s important to talk about the scope of a story before much of the reporting gets under way. I don’t want to be rigid about it — we can increase or decrease the scope depending on what the reporter finds out. But it’s important for the reporter and editor to agree on the story’s ambitions at the beginning, and then adjust as the reporting progresses.

I’ve also found that it’s not a good idea to tell the reporter, “Write what you think the story deserves.” In the newspaper world, if a story deserves a lot of space, let’s talk about it ahead of time, and I will fight for that space. But both the reporter and the editor will benefit from having a starting point and shared expectations for how ambitious we both will be.

U.S health initiative cuts maternal deaths by third

The first year of the Saving Mothers Giving Life initiative meant to reduce maternal mortality saw deaths from childbirth cut by a third, according to a report released January 9.

Saving Mothers’ first annual report, Making Pregnancy and Childbirth Safe in Uganda and Zambia details outcomes from the first year of the five-year initiative which began in June 2012.

It demonstrates that there is a 30 per cent decrease in maternal mortality in the target districts of Kabarole, Kibaale, Kamwenge, and Kyenjojo in Uganda and 35 percent in four of Zambia’s districts.

This initiative is led by the U.S Global Health Initiative (GHI), in partnership with Merck for Mothers, the American College of Obstetricians and Gynaecologists, Every Mother Counts, Project C.U.R.E. and the Government of Norway.

The U.S. committed $75m to this partnership.

“Uganda has not only seen a 30 percent reduction in maternal mortality in the four districts participating in the program, but has also registered a 28 percent increase in the number of women who received prevention of mother-to-child transmission of HIV/Aids services, said Dr Jane Ruth Aceng, Director General of the Ministry of Health during the report launch in Washington, D.C.

A gynecologist attends to a pregnant woman at Mulago Referral Hospital

She also said the districts increased the number of facilities providing basic emergency obstetric and newborn care and trained and hired 147 new doctors, nurses, and midwives.

With greater access to obstetric care, deaths from haemorrhage and obstructed labour were also reduced.

Health workers were trained to address childbirth-related complications affecting newborns, and saw an 11 percent reduction in institutional prenatal mortality.

Additionally, the districts also saw a 27 percent increase in the number of infants who received HIV prophylaxis and increase in the number of women giving birth in health facilities.

USAID administrator Dr Rajiv Shah said that in Uganda alone, 30,000 transportation vouchers provided by Saving Mothers, were redeemed and used.

Zambia and Uganda are the first two countries to operationalise the initiative because of their high ratios of maternal mortality. Uganda continues to struggle with high numbers of women who die during pregnancy and from complications of childbirth.

It is estimated 438 women out of every 100,000 die in pregnancy or childbirth every year – ranking Uganda 141 out of 172 high burden countries globally.